1. Nottingham CCG Practice Manager Session 2 December 2014

2. Objectives  Whistleblowing – what it is and why it matters  Myth busting – the real experience of whistleblowing  Legal rights  Your policy  Receiving concerns  Case study

3. A worker raising a concern about wrongdoing, risk or malpractice with someone in authority either internally and/or externally (i.e. regulators, media, MPs) Source: PCaW What is whistleblowing?

4. GrievancesConcerns risk is to selfrisk is to others need to prove casetip off or witness rigid processpragmatic approach legal determinationaccountability private redresspublic interest ©PCaW 2014 - 00 44 20 7404 6609 Grievances and concerns

5. Source: PCaW Advice line We have advised over 17,000 whistleblowers to date. Top sectors: health, care, local government, charities, financial services. Top concerns: financial malpractice, public safety and patient safety.

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7. 26 June 2014 thejournal.ie Former government contractor could join President Obama, Henry Kissinger and Nelson Mandela in historic list. 29 January 2014 The Independent Tesco's £250m accounting black hole first flagged during Phil Clarke's reign A Tesco employee who highlighted that the supermarket had over-stated first half profits to the tune of £250m first told his superiors of the problem when Philip Clarke was still in charge of the retail giant 24 October 2014 The Telegraph NSA whistleblower Edward Snowden is nominated for Nobel Peace Prize Whistleblower Michael Woodford settles with Olympus? The British chief executive who blew the whistle on a $1.7bn (£1bn) corporate fraud at Japanese electronics giant Olympus has brokered an out-of-court deal with the company over his sacking, believed to involve a multi-million pound pay-out. 29 May 2012 The Telegraph ©PCaW 2014 - 00 44 20 7404 6609 Staff at hospitals enabled Savile and refused to believe his victims Throughout each of the 28 reports into Jimmy Savile’s abuse at hospitals in the UK, one theme repeatedly emerges: how staff ignored, and in some cases, enabled him. Whistleblowing now

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9. Keep quiet? Go Outside? Raise internally? A concern about malpractice ©PCaW 2014 - 00 44 20 7404 6609

11.  The majority of whistleblowers (44%) raise a concern only once and a further 39% go on to raise their concern a second time. Majority (83%) will only try internal options once or twice and then give up. Small window of opportunity to address wrongdoing Importance of front line and middle management training  Very few are persistent in raising their concern- only 22 individuals from our research went on to raise their concern 4 times. Myth 1: Whistleblowers are persistent

12.  83% of whistleblowers blow the whistle internally.  Supported by YouGov survey in 2013: The majority of working adults in Great Britain (83%) said if they had a concern about possible corruption, danger or serious malpractice at work they would raise it with their employers. Myth 2: Whistleblowing is always going outside

13.  60% of those who called our advice line did not report any response from management (either negative or positive).  Of the 40% who told us of a response, the most common action is formal action short of discipline and 15% were dismissed.  Our YouGov 2013 survey: overwhelming majority of British workers (72%) view the term whistleblower as positive or neutral Myth 3: Whistleblowers are always trashed

14.  74% of whistleblowers say that nothing is done about the wrongdoing. They want the concern to be addressed.  Majority of respondents to the Whistleblowing Commission did not want a system of financial rewards.  Rewards are not a substitute to strong legal protection. More needs to be done to strengthen legal framework- the Public Interest Disclosure Act 1998. Myth 4: Whistleblowers only want money

15. EY Survey Headlines 93% of respondents said they have formal whistleblowing arrangements in place But 1 in 3 think their whistleblowing arrangements are ineffective 54% said they do not train key members of staff designated to receive concerns 44% confuse personal complaints with whistleblowing 1 in 10 say their arrangements are not clearly endorsed by senior management ©PCaW 2014 - 00 44 20 7404 6609

16. YouGov Survey Headlines 1 in 10 workers said they had a concern Two thirds of workers raised their concern 83% of workers said if they had a concern about possible corruption, danger or serious malpractice at work they would raise it with their employers 42% of workers said their employers have a whistleblowing policy 72% of workers view the term whistleblower as positive or neutral ©PCaW 2014 - 00 44 20 7404 6609

18. Lord Nolan’s praise for ‘so skilfully achieving the essential but delicate balance between the public interest and the interest of the employers’. The Public Interest Disclosure Act 1998

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20. Your policy messages The role of managers Training What you expect from staff Independent advice Review of arrangements Whistleblowing arrangements

21. Developing procedures - consult staff and their representatives Clear, written procedures should be available to staff detailing: Avenues for raising concerns including senior managers, an identified senior executive and/or board member and relevant external organisations Assurances of protection from reprisal That confidentiality will be maintained where requested Clear communication about processes, time frames and final outcomes How to access to independent advice That there is a zero tolerance of the victimisation of whistleblowers Training on whistleblowing arrangements at all levels Whistleblowing Commission: Code of Practice

22. Managers: Do you know…? What is whistleblowing? How do I know which policy to use? What support do I have in handling? When should I seek help? From whom? What is my role in promoting whistleblowing? When do I record? Where? Patient safety? Where to go? Relationship with safeguarding?

23. Managers: Key questions to ask IMMEDIATE RISK 5 Ws - who, what, how, where and when Why now? Broader context What has been done already Any solutions? Identity - prepared to share with you? Who else? What do you want to happen? Willingness for formal statement

24. Managers: Key issues to discuss Assurances  done the right thing  support  their protection  confidentiality and limitations Managing expectations Timescales, process and feedback

25. o Lead by example: engage with staff regularly, encourage them to raise concerns o Thank those who do come forward, if they are mistaken, reassure and explain o Acknowledge concerns about their own position and give reassurances reprisals will not be tolerated o Manage expectations if necessary and respect confidentiality o Discuss feedback options o Investigate - serious? Who else should be notified? Any external agencies? o Be mindful of the confidentiality of others i.e. the accused o Keep records of serious concerns raised - anonymising where necessary Handling the concerned employee: Top tips

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27. Consider: Number and types of concerns raised and outcomes of investigations Feedback from individuals who have used the arrangements Complaints of victimisation Complaints of confidentiality breach Other existing reporting mechanisms Adverse incidents (e.g. patient complaints, publicity or wrongdoing identified by third parties); Disputes / Litigation Staff awareness, trust and confidence in arrangements. Whistleblowing Commission: Code of Practice How effective are your arrangements?

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29. Case study: Slide 1 You are a long-serving Practice Manager at a small practice led by two partner GPs. Kwame is a salaried GP who has been with the practice for 18 months. Kwame has noticed that one of the partners, Bill, is in at the crack of dawn and leaves later than everyone. His appointments always overrun, he sends emails to staff in the early hours and often comes in over the weekend. What seemed to be dedication is now becoming more worrying, and Kwame is increasingly concerned that Bill is suffering from stress.

30. Case study: Slide 2 Bill looks exhausted and unkempt, he is constantly unwell but does not take time off. More worryingly, Kwame has seen three patients this week who have been referred by Bill for investigatory tests that seem to be unnecessary. When Bill’s regular patients have turned up at Kwame’s clinic he has noticed that they seem to be on medication that seems over the top for the conditions they are treating. Bill’s Registrar has just finished her placement and mentions to Kwame she thinks someone ‘needs to keep an eye on Bill’, without elaborating. Kwame is worried for Bill’s health and wellbeing and feels it is only a matter of time before something goes seriously wrong.

31. Case study: Slide 3 Kwame’s instinct is to talk to Bill about it so he asks for five minutes with Bill at the end of clinic. Bill gets irate and cuts Kwame off, ‘I do the very best for my patients’ he says and ‘if I want a second opinion, I’ll ask for one’. He asks Kwame to leave and let him get on with his work. Kwame doesn’t feel able to approach Bill again and so decides to speak to the other practice partner, Judy. She is dismissive, ‘the patients aren’t complaining’ she says. Kwame would like to get Bill some support for his stress, but he doesn’t know where else to go. He researches some options for raising the concern with the CCG or NHS England, but doesn’t feel any clearer. He then decides to speak to the GMC for advice.

32. Case study: Slide 4 The GMC tell Kwame they are taking the concerns as a referral under Fitness to Practice and they launch a case against Bill. The situation escalates fast and Kwame feels he has lost control. Everyone in the practice is pointing the finger at him, the atmosphere is terrible and people avoid talking to him. Bill’s patients are furious. Kwame can’t believe he has got himself into this situation. He doesn’t believe Bill is a bad doctor, he just wanted to get him some help and prevent patient harm. Now he’s wondering if he’ll still have a job himself.

33. Case study: Questions Kwame 1. What else could Kwame do in the circumstances? What could he have done differently? Practice Manager 2. What could you have done to encourage Kwame to approach you as Practice Manager? 3. When would have been best for Kwame to approach you? 4. What other questions do you have for Kwame? 5. How should you have handled the matter when it was brought to you?